Peak Practice it ain't! (My Experiences and Advice)

Name: chrispitts

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Product:	My Experiences and Advice
Date:	11.10.01 (36 review reads)
Rating:

Advantages: Less on calls, Less hierarchical, Patient contact

Disadvantages: Paperwork, Administration, Time intensity

Let me make this very clear right from the start... I HATED hospital medicine. With a vengeance. There was absolutely nothing I enjoyed about it. No, sorry, one thing - I met my wife during my Accident and Emergency job - I guess that was a bonus!

So, having slaved through medical school, suffered house-jobs (and despite what people say, 72 hour on-calls still happen from time to time), and tolerated various specialities (Care of the Elderly, Accident and Emergency, Obs/Gynae, and ENT/Ophthalmology, for anyone interested!), I finally made it to "General Practice Land".

If you're picturing General Practice Land as being pink and fluffy, with lots of bright colours, and soft, furry animals, you're not alone. In fact, nearly all of my colleagues going through hospital training for general practice talk of seeing the "light at the end of the tunnel".

And what a light it is! I have to say, I haven't been disappointed yet. There are so many good things about being a GP, I almost don't know where to start...

Patient relationships.
In hospital medicine, you have patients for a stay on the ward, you're looking after 30 or 40 at a time, and then they go home. If you're lucky, you'll see them again in clinic, if not, it'll be someone else. But in general practice you get a real chance to build long-term relationships with your patients. You ask them to come back next week or next month. They come back (usually!). You chat to them about their health, but also (more importantly?) their concerns, their lives, their families, what's going on in the news... and then, before you know it, they are thanking you for listening, and giving you bottles of whisky for Christmas. You tell me - is that job satisfaction or what?!

Bleep free.
Hospital doctors dread their bleeps/pagers. Their lives are ruled by them. One of my colleagues broke down at 2 in the morning, after continual b
leeps from the wards, and flushed her bleep down the toilet. It really is a nightmare - it has to be experienced to be believed.
The oncall system for most GPs is much more civilised. Often, there is a triage system for out of hours calls - ours is done by the community hospital staff. It's pretty rare for a GP to get called after midnight when on call, and most GPs are only on call once every couple of weeks. (depending on whether there is a co-op scheme for on calls, or a deputizing service). If there is a deputizing service, GPs can get away with no out of hours work at all. Not bad!

Lunchtime.
I'm finally free of hospital food indigestion. On the rare occasions I managed to get something to eat at lunch, it was almost always interrupted by a bleep or phone call - people get sick at the most inopportune times! And now, in GP Land? If I do my visits straight after morning surgery, and do the paperwork after evening surgery, that gives me about 2 hours for lunch. Bleep free, phone free... a bit more civilized, I'm sure you'd agree.

Bossy bosses?
You know that surgeon in Holby City? Or the one in ER? The really snotty ones, who think they know everything, and make everyone else feel stupid? And you don't think people like that exist in today's NHS. Ha ha ha. They do. Many of them do. And it makes a junior doctor's life a complete misery. Imagine dreading going into work so much, in case you get embarrassed in front of ward staff, patients, visitors... Again, excuse the anecdotes, but I've seen a surgeon shout down the length of a hospital ward to his house officer (fortunately not me) "There you are, you f**king lazy sh*t! You'd better have a f**king good reason to be late." Another surgeon sent his medical students home to change because they had button-down collars. And the number of scalpels embedded in operating theatre walls, thrown by angry consultants...
General Practitioners a
re much more... chilled (for want of a better word). There are disputes, sure, but they seem a bit more grown-up about the whole thing, and they treat everyone as equals.

There are bad sides to GP Land, of course. No-one can ignore the fact that being a GP is now like running a small business. You are responsible for the surgery building, the staff, and the equipment. You're tied down to a prescribing budget, and all sorts of other restrictions and rules. New guidelines and protocols come out all the time, and today's GP is supposed to absorb them all, and integrate them into day to day practice. Paperwork is increasing all the time. Referral letters, blood results, medical reports, journals, health authority mailings... much of which barely gets glanced at.

Continuing Medical Education is a big thing at the moment - GPs are supposed to hold a "Personal Development Portfolio", outlining all their meeting attendances, audits etc. I haven't yet met a GP who has time to do this.

Despite that, as you may have gathered, I'm a happy GP through and through. The privilage of seeing someone in their own home, of being part of their life... that's something you can never get in hospital.

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